Aveneu Park, Starling, Australia

Multi-compartment difficulty managing complex drug regimens and

Multi-compartment
compliance aids (MCA’s) are being increasingly used in both primary and
secondary care settings to assist patients with medicine compliance, in both a
safe and effective manner. The devices not only help patients to remember to
take their medication, but also acts as a visual prompt for carers enabling
them to see whether their patients have had their appropriate doses1.
  Additionally, these aids are an
indispensable tool in polypharmacy2, with the potential to reduce
wastage3. MCA’s
are particularly useful for the elderly population and the visually impaired who
may have difficulty managing complex drug regimens and are looking to promote
independence with their medicines4. The packaging allows days of the
week to be included, allowing patients to follow a specific drug regime,
organised by dosing intervals. Hence, minimising errors associated with
administrating incorrect doses at incorrect times. The pharmacist may arrange
the aids, placing different medications in the same compartment; allowing them
to keep track of the medication the patient is receiving every day, ensuring it
is taken at the desired time.

However, MCA’s pose a
concern regarding product stability as medicines are removed from their
manufacturers original packaging, and has even prompted pharmacists to
establish a database on product stability5. Repackaging may even be warranted as unlicensed
use of the product and may invalidate the stated expiry date2. The
original packaging has been designed with the appropriate pharmacopoeial and
quality standards in mind1, and dosage forms are required to meet
British Pharmacopoeial requirements including content uniformity. Other factors
which are considered during drug design are the effects of humidity,
temperature and oxygen. MCA’s cannot guarantee the same level
of protection, and the pharmacist must use their clinical judgment to prepare
one or not. The compliance aids are not air tight and provide less moisture
protection than original packaging. This may lead to chemical and physical
deterioration, reducing efficacy and compromising patient safety.  Often systems are re-used without cleaning posing
the risk of chemical and microbiological contamination. Also,
certain formulations cannot be repackaged including those which are refrigerated,
dispersible tablets, hygroscopic preparations and solid dose cytotoxic medications
such as methotrexate. The Royal Pharmaceutical Society also includes medicines with variable dosing and
a narrow therapeutic index such as warfarin6. 

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